Tuberculosis screening during the 2015 European refugee crisis

Abstract

Background: The purpose of our study was to describe and evaluate management, performance and results of Tuberculosis (TB)-screening among refugees and asylum seekers in a rural area in Germany in 2015.Methods: Refugees or asylum seekers, staying in shared-accommodation are obligated to participate on screening chest X-ray (CXR) in order to screen for signs of potentially infectious pulmonary TB (German Protection against Infection Act and German Asylum Procedure Act). n = 705 individuals underwent screening chest X-ray (CXR) to detect pulmonary TB in September and October 2015 on site. One experienced radiologist interpreted and reported each CXR within 24 h after the enrollment in the screening program and results were sent to the local Public Health Department for potential further medical care. Image abnormalities suggestive for TB were defined according to established radiographic criteria such as pleural effusion, cavitation, consolidation, fibrous scarring or calcification. Only in case of TB-suggestive findings on CXR, further diagnostics were arranged (pulmonological examination, follow-up CXR, sputum culture, interferon-gamma release assay, bronchoscopy). Follow-up data was collected in collaboration with the local Public Health Department. Descriptive statistics were calculated using GraphPad Prism software.Results: n = 637 CXR examinations (90%) did not show abnormal findings, n = 54 CXR (8%) showed incidental findings, and n = 14 CXR (2%) were suspicious for acute TB. Of these, n = 14 individuals, eight underwent further TB diagnostics. Active TB was confirmed in one individual (0.001% of the screening cohort). Conclusions:Our cohort reflects current immigrations statistics in Europe and illustrates an overall low TB prevalence amongst individuals entering Germany in 2015. However, our findings support the improvement of diagnostic algorithms.

Importance of Tuberculosis Screening of Resident Visa Applicants in Low TB Incidence Settings: Experience from Oman

“…The new algorithm made active screening for detecting TB among visa applicants more efficient compared to the symptom-based process used before which is reflected in the increased proportion contributed by active case detection in TB incidence rate since 2018 (Chart 1 ). The increasing trend in cases detected over the past 7 years and the increase noted by the new active screening process over the previous passive process supports validity of pre- and post-migration screening reports from other low-burden countries [ 17 , 18 , 22 ]. Given that only 11 out of 53 active cases detected had symptoms, it can be assumed that by utilizing the combination of chest X-ray with Xpert MTB tests in screening, an additional 42 cases were detected.…”

“…Similar findings were reported from other GCC countries as well as from the United Kingdom and Australia [ 8 , 17 – 21 ]. Screening strategies adopted by low-burden countries have substantial heterogeneity in screening criteria and the screening algorithms [ 22 – 24 ]. Oman’s strategy of pre-arrival screening, screening at entry, and follow-up screening provides a robust strategy with potential for strengthening [ 17 , 19 – 21 ].…”

Cross-sectional survey to describe medicine use among Syrian asylum seekers and refugees in a German federal state: looking beyond infectious diseases

“…29 In Germany, asylum seekers of all nationalities are obliged to participate in chest X-ray examinations to screen signs of potentially infectious pulmonary tuberculosis (except for pregnant women and children younger than 15 years of age). 33 Policies in Germany should account for the different regions where AS&Rs come from and the burden of diseases that could vary between these regions. Since 2015, the chest X-ray screening for tuberculosis for Syrian asylum seekers in the Netherlands was suspended as the tuberculosis incidence in Syria was low (<50 cases per 100 000 people).…”

Disease burden in a large cohort of asylum seekers and refugees in Germany

“…Previous publications focused on communicable diseases such as HIV (human immunodeficiency viruses), tuberculosis, hepatitis, scabies, etc., as well as the vaccination status. [ 9 - 12 ]. Although the overall prevalence of HIV, hepatitis B and C and tuberculosis appear to be low, certain refugee subgroups are particularly affected by these diseases [ 9 , 13 - 15 ].…”

“…[ 9 - 12 ]. Although the overall prevalence of HIV, hepatitis B and C and tuberculosis appear to be low, certain refugee subgroups are particularly affected by these diseases [ 9 , 13 - 15 ]. Thus far, few studies addressed the overall demand for medical care, or diagnoses and drug prescriptions in initial refugee reception settings [ 16 - 20 ].…”